支原体肺炎罕见合并严重自身免疫性溶血性贫血1例并文献复习  

Mycoplasma pneumonia was rarely complicated with severe autoimmune hemolytic anemia:1 case and literature review

作　　者：张庆 张硕 王祥民 桑威 ZHANG Qing;ZHANG Shuo;WANG Xiangmin;SANG Wei(Department of Hematology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院血液科,江苏徐州221002

出　　处：《徐州医科大学学报》2023年第9期685-688,共4页Journal of Xuzhou Medical University

基　　金：江苏省青年医学重点人才项目(QNRC2016791);江苏省自然科学基金(BK20171181);江苏省科技厅社会发展重点项目(BE2019638)。

摘　　要：目的研究成人支原体肺炎(mycoplasma pneumonia,MP)继发严重自身免疫性溶血性贫血(autoimmune hemolytic anemia,AIHA)的临床特征和治疗方法。方法选取徐州医科大学附属医院血液科收治的1例MP并发AIHA的病例,结合患者诊治经过以及万方和PubMed上检索到的相关文献对其临床特点进行分析。结果患者入院诊断为MP并发溶血性贫血,予支持治疗,抗感染以及免疫抑制治疗后,黄疸渐消退,贫血症状逐渐改善。复查胸部CT:左肺炎症较前明显吸收,血红蛋白(HGB)上升,患者病情好转出院。复习国内外收集到的15例数据较完整的病例,男性6例,女性9例,中位年龄34岁。大部分获得治愈,1例遗留神经功能损伤,1例出现肺栓塞,2例并发溶血性尿毒综合征,1例死于严重的多器官功能衰竭。结论MP伴发AIHA极为罕见,当出现不明原因的贫血、黄疸以及周围循环衰竭等症状时,应警惕溶血性贫血的发生,大部分早期治疗患者预后较好,少数合并严重并发症可致死亡。Objective To investigate the clinical features and treatment approaches for adults with severe autoimmune hemolytic anemia(AIHA)secondary to mycoplasma pneumonia(MP).Methods A case of MP complicated with AIHA admitted to the Department of Hematology at Affiliated Hospital of Xuzhou Medical University was reported.We analyzed the clinical characteristics of the patient based on her diagnosis and treatment process,along with relevant literature retrieved from Wanfang and PubMed.Results The patient was diagnosed with mycoplasma pneumonia complicated by hemolytic anemia.After receiving anti-infection and immunosuppressive treatments,the jaundice gradually resolved,and the patient′s anemic condition improved.The Chest X-ray showed that the inflammation in the left lung was absorbed.Routine blood tests showed an increase in hemoglobin(HGB)levels.The patient was discharged in a good condition.We reviewed 15 cases of AIHA secondary to MP from domestic and international sources,with a median age of 34 years,including 6 males and 9 females.Most patients achieved a complete recovery,one case experienced residual neurological impairment,one developed pulmonary embolism,two had concomitant hemolytic-uremic syndrome,and one patient succumbed to severe multi-organ failure.Conclusions The occurrence of MP associate with AIHA is extremely rare.When unexplained anemia,jaundice,and peripheral circulatory failure occur,caution should be exercised for the development of hemolytic anemia.Early treatment leads to a better prognosis for most of the patients,while a few may experience severe complications that result in death.

关 键 词：支原体肺炎 自身免疫性溶血性贫血 激素 循环衰竭 溶血性尿毒综合征 

分 类 号：R551[医药卫生—血液循环系统疾病]